The Tribune

By Dr Graham Cates

HEART diseases and stroke are the number one causes of death and disability among people with type 2 diabetes. In fact, at least 65 per cent of people with diabetes die from some form of heart disease or stroke.

Adults with diabetes are two to four times more likely to have heart disease or a stroke than adults without diabetes.

The American Heart Association considers diabetes to be one of the seven major controllable risk factors for cardiovascular disease.

Why are people with diabetes at increased risk for CVD?

Diabetes is treatable, but even when glucose levels are under control it greatly increases the risk of heart disease and stroke. That’s because people with diabetes, particularly type 2 diabetes, often have the following conditions that contribute to their risk for developing cardiovascular disease.

• High blood pressure (hypertension)

High blood pressure has long been recognised as a major risk factor for cardiovascular disease. Studies report a positive association between hypertension and insulin resistance. When patients have both hypertension and diabetes, which is a common combination, their risk for cardiovascular disease doubles.

• Abnormal cholesterol and high triglycerides

Patients with diabetes often have unhealthy cholesterol levels including high LDL (“bad”) cholesterol, low HDL (“good”) cholesterol, and high triglycerides. This triad of poor lipid counts often occurs in patients with premature coronary heart disease. It is also characteristic of a lipid disorder associated with insulin resistance called atherogenic dyslipidemia, or diabetic dyslipidemia in those patients with diabetes. Learn more about cholesterol abnormalities as they relate to diabetes.

• Obesity

Obesity is a major risk factor for cardiovascular disease and has been strongly associated with insulin resistance. Weight loss can improve cardiovascular risk, decrease insulin concentration and increase insulin sensitivity. Obesity and insulin resistance also have been associated with other risk factors, including high blood pressure.

• Lack of physical activity

Physical inactivity is another modifiable major risk factor for insulin resistance and cardiovascular disease. Exercising and losing weight can prevent or delay the onset of type 2 diabetes, reduce blood pressure and help reduce the risk for heart attack and stroke. It’s likely that any type of moderate and/or vigorous intensity, aerobic physical activity—whether sports, household work, gardening or work-related physical activity—is similarly beneficial.

• Poorly controlled blood sugars (too high) or out of normal range

Diabetes can cause blood sugar to rise to dangerous levels. Medications may be needed to manage blood sugar.

• Smoking

Smoking puts individuals, whether or not they have diabetes, at higher risk for heart disease and stroke. Learn how to kick the habit.

Individuals with insulin resistance or diabetes in combination with one or more of these risk factors are more likely to fall victim to heart disease or stroke. However, by controlling these risk factors, diabetes patients may avoid or delay the development of heart and blood vessel disease. Your health care provider will do periodic testing to assess whether you have developed any of these risk factors associated with cardiovascular disease.

• Dr Graham Cates is the medical director of the Family Medicine Centre and founder of ACE Diabetes.